Long Term Disability Claims Specialist II
Summary: You need decision-making experience, critical thinking, problem-solving skills, strong communication, customer service, conceptual thinking, plus time management. A degree and 1-3 years in claims are preferred. You will manage complex claims, conduct thorough reviews, communicate with claimants and stakeholders, analyze data, resolve complaints, and ensure accurate benefit calculations.
Requirements
Description and Requirements Role Value Proposition: At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The Global Technology & Operations group (GTO) is a diverse team of engineers, developers, business analysts, claims analysts and project managers with the freedom to create innovative and solutions to address core business challenges with MetLife. This role will provide exemplary customer service by processing group disability claims in a timely and accurate fashion. Job Title: Long Term Disability Claims Specialist II Job Location: 100% Virtual US Role Summary: At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The LTD Claims Specialist II evaluates long term disability insurance claims in accordance with plan provisions and within prescribed time service standards. In this role, the LTD Claims Specialist is required to exercise independent judgment, critical thinking skills, exemplary customer service skills as well as effective inventory management skills. Key Responsibilities: Effectively manages with some level of oversight an assigned caseload of moderately complex claims which consists of pending, ongoing/active and appeal reviews. The LTD CS will be evaluated for increases in their authority levels as they become more experienced in their decision-making and demonstrate consistency in meeting all key performance indicators Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations. Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions. These calls are used to gather essential details regarding medical condition(s) and treatment, occupational demands, financial information and any other information that may be pertinent to the evaluation of the claim. Once telephone calls are completed, you will be required to document the conversation within the claim file in a timely manner utilizing the appropriate level of detail and professional writing skills Interacts and communicates effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available Collaborates with both external and internal resources, such as physicians, attorneys, clinical/vocational consultants as needed to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions. Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination. Addresses and resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas. Essential Business Experience and Technical Skills: Required: Prior experience with independent judgement and decision making while relying on the available facts Be able to demonstrate the use of critical thinking and analysis when reviewing the information Creative problem-solving abilities and the ability to think outside the box Excellent interpersonal and communication skills in both verbal and written form Excellent customer service skills proven through internal and external customer interactions Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively Organizational and time management skills Preferred: Bachelors degree 1-3 years of LTD/IDI Insurance Claims experience Business Category Operations - Claims Travel Not applicable At MetLife, were leading the global transformation of an industry weve long defined. United in purpose, diverse in perspective, were dedicated to making a difference in the lives of our customers. The salary range for applicants for this position is 41,600 to 65,300.
Benefits
We Offer Our U.S. benefits address holistic well-being with programs for physical and mental health, financial wellness, and support for families. We offer a comprehensive health plan that includes medical/prescription drug and vision, dental insurance, and no-cost short- and long-term disability. We also provide company-paid life insurance and legal services, a retirement pension funded entirely by MetLife and 401(k) with employer matching, group discounts on voluntary insurance products including auto and home, pet, critical illness, hospital indemnity, and accident insurance, as well as Employee Assistance Program (EAP) and digital mental health programs, parental leave, volunteer time off, tuition assistance and much more! About MetLife Recognized on Fortune magazine's list of the 2024 "World's Most Admired Companies", Fortune Worlds 25 Best Workplaces for 2024, as well as the 2024 Fortune 100 Best Companies to Work For ®, MetLife , through its subsidiaries and affiliates, is one of the worlds leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East. Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by empathy, were inspired to transform the next century in financial services. At MetLife, its #AllTogetherPossible . Join us! Equal Employment Opportunity/Disability/Veterans If you need an accommodation due to a disability, please email us at [email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process. MetLife maintains a drug-free workplace. 41,600 to 65,300 Requirements: Required: Prior experience with independent judgement and decision making while relying on the available facts Be able to demonstrate the use of critical thinking and analysis when reviewing the information Creative problem-solving abilities and the ability to think outside the box Excellent interpersonal and communication skills in both verbal and written form Excellent customer service skills proven through internal and external customer interactions Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively Organizational and time management skills Preferred: Bachelor's degree 1-3 years of LTD/IDI Insurance Claims experience Responsibilities: Effectively manages with some level of oversight an assigned caseload of moderately complex claims which consists of pending, ongoing/active and appeal reviews. The LTD CS will be evaluated for increases in their authority levels as they become more experienced in their decision-making and demonstrate consistency in meeting all key performance indicators Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions. These calls are used to gather essential details regarding medical condition(s) and treatment, occupational demands, financial information and any other information that may be pertinent to the evaluation of the claim. Once telephone calls are completed, you will be required to document the conversation within the claim file in a timely manner utilizing the appropriate level of detail and professional writing skills Interacts and communicates effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available Collaborates with both external and internal resources, such as physicians, attorneys, clinical/vocational consultants as needed to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination Addresses and resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas Apply Job!